Differential Diagnosis for Rash to Hands and Feet in a 10-Year-Old with Fever and Joint Pain
- Single Most Likely Diagnosis
- Kawasaki Disease: This condition is a leading cause of acquired heart disease in children. The presentation of fever, rash, joint pain, and specific involvement of hands and feet (with desquamation in the subacute phase) aligns closely with Kawasaki disease, especially in the absence of other clear etiologies.
- Other Likely Diagnoses
- Juvenile Idiopathic Arthritis (JIA): While JIA can present with joint pain and sometimes rash, the specific distribution of the rash to hands and feet, along with fever, might suggest a systemic subtype of JIA.
- Infectious Exanthems: Various viral infections (e.g., enterovirus, parvovirus B19) can cause rashes and fevers in children. The distribution of the rash and the presence of joint pain could be consistent with certain infectious exanthems.
- Henoch-Schönlein Purpura (HSP): Although HSP typically presents with a purpuric rash on the lower extremities and buttocks, it can occasionally involve the hands and is accompanied by joint pain and sometimes fever.
- Do Not Miss Diagnoses
- Meningococcemia: This is a life-threatening condition that can present with a rash (often petechial or purpuric), fever, and joint pain. Early recognition and treatment are crucial.
- Rocky Mountain Spotted Fever (RMSF): Characterized by fever, headache, and a rash that can appear on the hands and feet, RMSF is a tick-borne illness that requires prompt diagnosis and treatment to prevent serious complications.
- Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: These are severe skin and mucous membrane disorders, usually a reaction to medication or infection, which can present with fever, rash, and significant morbidity.
- Rare Diagnoses
- Systemic Lupus Erythematosus (SLE): Although rare in children, SLE can present with a variety of symptoms including rash, fever, joint pain, and involvement of multiple organ systems.
- Dermatomyositis: An inflammatory disease characterized by skin rash and muscle weakness, which can occasionally present with joint pain and fever.
- Sarcoidosis: A condition that can affect multiple parts of the body, including the skin, joints, and lungs. It is rare in children and can present with a variety of symptoms including rash and joint pain.